A 50 year old man, was offered a job in an off-shore rig-ship. He never works in the sea before.

Unfortunately, in the day he went to the rig-ship, the wind in the sea was so high and maked high wave. He could not stand this kind of situation. He suffered vomiting. Almost every 5 minutes he vomited. He just stays in his room alone. He looks very weak and had no power at all. The doctor send him to the Siloam hospital. Blood pressure 90/70 mmH, RR 30 X/min. Some blood chemistry data shows: Na+ 155 mEq/L K+ 3,5 mEq/L Glucose 100 mg/dl BUN 15 mg/dl 1. What is the osmolality of the extracellular fluid of patient above?: a. 260 mosm/L b. 270 mosm/L c. 290 mosm/L d. 300 mosm/L e. > 310 mosm/L 2. Which of following conditions is the most appropiate for him? a. hyponatremia b. dehydration c. hyperhydration d. hypoglycaemia e. normohydration 3. To compensate the above condition and to reach the homeostasis, the posterior pituitary gland secretes a hormone. What is the effect of this hormone? a. Increase sodium reabsorption b. Increase sodium excretion c. Increase water excretion d. Increase water retention e. Increase potassium retention 4. Maintain correct body temperature range in order to: a. minimize metabolic efficiency b. increase oxygen use c. maintain enzyme function d. reduce calorie expenditure e. body balance

5. While examining a tissue, you notice a small vessel, its round lumen lined by endothelial cells and a few layers of smooth muscle. Which of the following are you examining? a. A blood capillary b. An arteriole c. A small artery d. A small vein e. A small lymphatic 6. A medical student took the mans oral temperature. Which of the following statement is most appropriate regarding the oral temperature of a normal person? a. It reflects the core temperature b. it does not follow a circadian rhythm c. it is 0.5C higher than the rectal temperature d. It is affected by many factors such as ingestion of cold fluids e. It is measured using a maximum thermometer placed on the tongue for 1 minute 7. Upon rising from a supine position, what is the immediate effect on the young womans blood pressure ? a. blood pressure falls b. blood pressure rises c. systolic pressure rises d. diastolic pressure is unchanged e. blood pressure remains unchanged 8. Blood pressure was low and the doctor asked the student for the patients pulse pressure. Which statement is true regarding pulse pressure? a. will increase if there is loss of blood b. will decrease if there is loss of arterial elasticity c. is the difference between systolic pressure and diastolic pressure d. is equal to the mean arterial pressure during systole and diastole e. is the average pressure in the ventricles during ventricular contraction Siti, an infant of 1 month, was brought for the first time to the Pediatric Clinic. After examining Siti, the pediatrician concluded that Siti was healthy and got her 1st vaccination shot for DPT + P. 9. One reason why vaccine fail to work in very young infants is the presence of a. maternal Ab b. glycoproteins c. endotoxin d. adjuvant

e. serum 10. What is an auto-antigen? a. antigen from bacteria b. self-antigen c. artificial antigen d. carbohydrate antigen e. nucleic acid 10. A 28 year old male sustained severe burns while welding an automobile gasoline. His friends took him immediately to regional burn center. On admission,initial assessment revealed that he got full thickness burns on his face, to both of his arms and hands bilaterally and circumferentially and to the anterior trunk. The burned total body surface area (TBSA) was 35 percent. What will happen quickly after major burn injury? a. Renal failure b. Syncope c. Shock septic d. Shock anaphylactic e. Shock hypovolemic 11. A patient suffers from duodenal ulcer bleeding caused by an ulcer. In the emergency unit, the blood pressure has changed from 140/80 to 95/75 mmHg (Systolic/Diastolic arterial pressure), his heart rate from 70 to 140/min. Hematocrit is 36%, Hb is 8 g/dL and the skin is cold. Which of the following condition would be expected in this situation? a. b. c. d. e. Increased glomerular filtration rate (GFR) Decreased venous tone by parasympathetic stimulus O Decreased sodium and water retention in the body Decreased sympathetic stimulus due to baroreceptor reflex Increased renin serum with the following increase of Angiotensin II

12. The hematopoietic progenitor system can be envisioned as a continuum of functional compartments with the most primitive compartement composed of very rare cells known as: a. Pluripotent stem cells b. Multipotent stem cells c. Monopotent stem cells d. Lymphoid stem cells e. Myeloid stem cells

13. A wide laceration to the left hand of an 18 year old male was sutured, and after the sutures were removed a week later, healing still continued. However, the site of the wound became disfigured by a prominent raised, nodular scar that developed over the following 1 month. Which of the following aspects of wound healing is most likely to be deficient ? a. Platelet-derived growth factor b. Epidermal growth factor c. Fibroblast growth factor d. Growth inhibiting factor e. Growth stimulating factors 14. A 6 year old child touches a hot iron by her fingers. Within several hours, there is marked hyperemia of the skin o f the fingers pads. What is the most likely cause of erythema of the skin: a. Vasodilatation vascular and extravasation erytrocytes b. Vasoconstriction and vasodiatation c. Vasodilatation and fluid exudate d. Increase permeability vascular and vasocontriction e. Pavementing and margination leucocytes 15. A 50 year old male has experienced mid upper abdominal pain for several weeks. An endoscopy reveals a duodenal lesion, which is the surfaces eroded Which of the following terms best describes this process ? a. Perforation b. Ulceration c. Abcess d. Fistulous tract/fistula e. Granuloma 16. A 25-year-old man always exercises in gymnastic studio. His arm were bigger and bigger, especially involved deltoid, biceps, and triceps muscles. Which of the following is the appropiate for the kind of growth? a. Dystrophy b. Hyperplasia c. Hypertrophy d. Metaplasia e. Hypoplasia 17. Three weeks after a meal at the schools cafe,a 17 year old male develops malaise. He has a mild scleral icterus, fatique and loss apetite. His symptoms abate over the next weeks. Physical examination reveals liver enlargement, tense with blunted edge. Fine needle

aspiration biopsy was performed. Microscopic shows hydrophic degeneration in dominant hepatocytes. Which of the following conditions of dominant hepatocytes is most closely associated to the process? a. Acute inflammation b. Chronic non spesific inflammation c. Chronic spesific inflammation d. Granulation tissue formation e. Granuloma formation

18. A patient was given a 160-mg dose of a drug IV, and 80 mg was eliminated during the first 120 minutes. If the drug follows first-order elimination kinetics, how much of the drug will remain 6 hours after its administration? a. 0 mg b. 10mg c. 20mg d. 40 mg e. 60 mg 19. A boy who suffering from viral infection. Antibody IgG and IgM was detected on the laboratory examination. Which of the following body response is most appropriate for this condition? a. Physical barrier b. Chemical barrier c. Inflammatory mediators d. Humoral immunity e. Hypersensitivity

20. A-33-year-old woman came to the neurosurgeon clinic complained of visual disturbance, frequent urination, progressive headache and irregular menstruation period along the other symptoms. The doctor found that she had polyuria. After completing several examinations, the doctor diagnosed that she had posterior pituitary tumor. What hormone is the most likely to be disturbed? a. Atrial natriuretic peptide b. Aldosterone c. Vasopressin d. Thyroid Stimulating Hormone e. Gonadotropine

21. A-22-year-old woman brought to the emergency room because of loss of consciusness. Her friends said that about an-hour before they had lunch together in the seafood restaurant and suddenly the woman fell down to the floor with flushing in all her body. The doctor said that this is an emergency case because he found that the patient was shock and might happen after severe allergic reaction. What happened with the circulatory system? a. Loss of blood volume b. Loss of vascular tone c. Loss of fluids d. Release of vasodilator substances e. Release of serotonine 22. A-30-year-old man brought to emergency room because of severe bleeding. The man was experienced car accident and so badly injured in his thigh. The man became drowsy and looked a bit pale, his extremities start looking blue. What is the compensation of hemorrhage? a. Capillary blood pressure b. Firing of baroreceptor c. Sympathetic activity d. Parasympathetic activity e. Renal blood flow 23. A 10 years old boy got fever for 3 days. He had cough, sore throat, and loss appetite. From the physical examination that was redness in his pharynx and the tonsil also inflamated. The result of laboratory blood test : Hb 11 g/dl, Ht 38%, leukocyte 13000/l, platelet 200.000/l. The doctor diagnosed him with tonsilopharingitis acute. What substance that can cause fever in this case? a. Epinephrine b. Cytokins c. Norepinephrine d. Toxin e. Prostaglandin 24. A 16 years old man was brought to emergency department in unconscious state due to multiple trauma with severe hemorrhagic. Physical examination showed blood pressure 80/60 mmHg, heart rate 120 x/minute, respiration rate 20x/minute. Which of the following is the most likely cause the low blood pressure? a. decreasing of preload b. decreasing of load c. decreasing of after load d. decreasing of angiotensin

e. decreasing of arginine vasopresine 25. A 9 month baby was brought by her mother to your clinic for measles vaccination. what the cellular response will be stimulated by this vaccine? a. lymphocyte T b. lymphcyte B c. macrophage d. neutrophile e. eosinophyle 26. Heat is often transfered when a cold object comes in contact with skin. How the energy transfered? a. The transfer of thermal energy through electromagnetic waves b. The transfer of energy between neighboring molecules in a substance c. The movement of molecules within fluids d. the heat transfer via gap junction. e. The heat transfer between cell to cell 27. In the cardiac cycle, the systemic blood pressure changes with the action of the heart. Peak systolic pressure is associated with what action? a. Contraction of the left ventricle b. Relaxation of the left ventricle c. Contraction of the right ventricle d. Relaxation of the right ventricle e. The blood pump back to the heart 28. Body has several mechanisms to maintain body heat in normal temperature. What is the greatest source of body heat? a. The hypothalamus b. Prevention of sweating c. The environment temperature d. Constriction of blood vessels e. Contraction of skeletal muscle 29. An old man had hypertension after hearing bad news. What will the baroreflex do as the compensation to this high blood pressure? a. Increase cardiac output b. Increase stroke volume c. Decrease systemic vascular resistance d. Increase heart contractility

e. Arterial vasoconstriction 30. At the clinic, a doctor finds there is a patient with disease involving monocyte. As a coassistant, you are having difficuties differentiating between macrophage and monocyte. What is the doctors answer? a. Macrophages are phagocytic and monocytes release substances such as histamine into the bloodstream b. Monocytes are phagocytic and macrophages release substances such as histamine into the bloodstream c. Macrophges attack bacterial antigens exclusively and monocytes attack viral antigens exclusively d. Macrophages are able to discriminate between bacterial and viral antigens but monocytes are not able to do so e. They are the same type of cell but macrophages remain at one site and monocytes move through the bloodstream 31. A 67 years old woman, came to General Practitioner with complain palpitation and head ache. She suffered hypertension about 20 years and use diuretic for her disease. Physical examination : BP 150 /95, pulse : 65 X/minute irregular , irregular heart beat. EKG : prominent u waves with flat T. What the most possible electrolyte disturbance of this patient: a. Hypokalemia b. Hypomagnesemia c. Hyponatremia d. Hypocalcemia e. Hypophosphatemia 32. A 46 years old man came to a general practitioner with complain: edema in both lower extremity. He was a diabetic patient until 15 years ago and uncontrolled. Physical examination : Vital sign in normal limit, edema in both lower extremity. Laboratory result : Albumin decrease . Urinalysis : Albumin ++. What cause of edema in this patient : a. Decrease hydrostatic pressure b. Lowered plasma osmotic pressure c. Increase capillary membrane permeability d. Lymphatic channel obstruction e. Increase pressure in vessel 33. A 25 years old man come to Emergency Department with complain weakness and fatigue for 1 month, he is a narcotic user and always use one syringe together with his friends. In Physical Examination : Pale. Body weight : under normal limit, another examination in

normal limit . Laboratory examination : HIV + (pos). According this patient what kind of cell infected by HIV? a. B cells b. T cells c. NK cells d. Plasma cells e. Mast cells

34. A 65 years old man was brought by his son to emergency departement because of severe chest pain attack for 12 hours. He looked very pale and very tired. He has shortness of breath. Blood pressure 80/40 mmHg, heart rate 140 x/minute and weak pulse, respiratory rate 32 x/minute. both his low extrimities feel cold. What is the mechanism for his hypotension? a. Hypovolemia b. Vasomotor paralysis c. Anaphylactsis d. CNS injury e. Cardiac failure

35. A 30 year old woman is brought by her husband to Siloam hospital because of fatigue, myalgia and muscular weakness of both her leg for 1 week. She has history of hypertension, and she always consume antihypertensive drug continually. Laboratory result shows Na 140 mEq/L (N: 135-145), K 2.5 mEq/L (N: 3,5-5,5), Cl 100 mEq/L (N:97-107). What drug is the most probably cause this condition? a. Loop diuretic b. beta blocker c. ACE inhibitor d. Ca antagonist e. Angiotensin II receptor blocker 36. A 20 year old girl has hepatitis A with liver enlargement for 2 weeks.Fine needle Aspiration Biopsy was performed. Microscopic appearance results fluid accumulates in cytoplasma of hepatocytes. Which of the following reversible lesions appear dominantly in cytoplasma of hepatocytes ? a. Fatty changes b. Hydrophic degeneration c. Mucoid degeneration d. Amyloid degeneration e. Hyaline degeneration

37. A 32 years old male insulin dependent diabetic. He presents to the emergency department in severe ketoacidosis. He is sweating and his respiratory rate is 36. This response has what effect? a. Increases the rate respiratory acidosis b. Eliminates CO2 and decreases the level of circulating acid c. Increases bicarbonate in the urine d. Increases renal H+ secretion e. Increases carbonic acid production 38. A 23 years old male is in a motorcycle accident. There is a large bruise over his abdomen. In the emergency department, the BP is 80/40 with a pulse rate of 136. Which of the following commonly occurs? a. There is increased flow to the kidneys b. There is decreased cerebral blood flow. c. There is increased blood flow to the skeletal muscles d. There is decreased tissue perfusion to the skin e. There is increased preferential blood flow to the eyes 39. Mr.A is a 68 years old male who suffers a rupture of an aortic aneurysm. In the early stages of his blood loss, sympathetic neurons in the spinal cord cause release of high levels of catecholamines resulting in alpha1 actions and maintenance of perfusion. What is the neurogenic mechanism involved? a. Preganglionic fibres innervating the adrenal medulla b. Postganglionic fibres decreasing heart rate c. Postganglionic fibres causing arteriolar constriction d. Sympathetic fibres innervating sweat glands e. Sympathetic fibers innervating spinal cord